1. Emergencies in
dental practice
Instructor –
Dr.Jesus George
1

2. Common emergencies in
dental practice
 Syncope
 Chest pain
 Cardiac arrest
 Anaphylactic shock
 Stroke
2

3. Cont.
 Asthmatic attacks
 Drug reaction
 Bleeding
 Injuries as a result of surgical procedure
3

4. Syncope
 Syncope or fainting or loss of consciousness
 Fainting refers to sudden loss of
consciousness
 Predisposing factors – fear, anxiety, pain
- fatigue
- fasting
- hot & humid weather
4

5. Cont.
 Signs & symptoms – cold & moist skin
- slow pulse initially followed by rapid pulse
- pale skin
- dizziness
- weakness
- nausea
- loss of consciousness
5

6. Cont.
 Management – monitoring pulse
- lowering head to improve cerebellar
circulation
- loosening of tight cloths at neck
- smelling of salt of aromatic ammonia
- reassurance of patient
- if not recovered other causes of collapse
should be considered
6

7. Other causes of collapse
 Anaphylaxis
 Hypoglycemia in diabetic patient
 Myocardial infarction
 Uncertain causes
7

8. Collapse of diabetic patient
 Hypoglycemia
- dampness of skin
- rapid pulse
- irritability
- aggressiveness
- decreased blood sugar
- urine sugar is -ve
 Hyperglycemia
- dry mouth & skin
- weak pulse
- drowsiness
- disorientation
- increased blood sugar
- urine sugar is +ve
8

9. Cont.
 Management (hypo)
 If patient can take orally –
15g oral carbohydrate
 If the patient is unable to
take orally, i/v 25-50ml 50%
dextrose or 1mg glucagon
 If i/v line is not there, s/c or
i/m 1mg glucagon
 Patient is observed for 30-
60 min
 Management (hyper)
 immediate medical
assistance
 Maintenance of airway &
circulation , monitoring
vital signs
9

10. Uncertain causes
 Management – make the patient lie down flat
& monitor pulse
- administer oral glucose
- maintenance of airway
- administer oxygen
- i.v. hydrocortisone sodium succinate 250 mg
10

11. Chest pain
 Mainly caused by angina pectoris, myocardial
infarction
 Angina pectoris – pain lasts for only a short
duration
 MI – pain persists for long duration
 Diagnosis – severe chest pain in retrosternal
region, dyspneoa, vomiting, weak pulse,
irregular pulse ( MI), loss of consciousness
11

12. Management
 s/l 0.5mg glyceryl trinitrate, if pain is not
relieved by 3 min. MI
 Nitrous oxide & oxygen 50/50 ratio to relieve
pain & anxiety, immediate medical attention
12

13. Cardiac arrest
 Sudden appearance of pallor & respiratory
arrest
 Etiology – MI
- Anaphylactic reaction
- severe hypotension
- hypoxia
- anesthetic overdose
13

14. Cont.
 Diagnosis – fainting or collapse
 Late signs – respiratory arrest, cyanosis,
dialatation of pupil, absence of pupillary
response to light, absence of BP
 Management – immediate cardiopulmonary
resuscitation
14

15. Anaphylactic shock
 Caused by drugs like penicillin
 C/Fs – wheezing
- abdominal pain
- nausea, urticaria
- flushing of face, paraesthesia
- pallor, rapid & weak pulse
- cyanosis, edema of face
15

16. Cont.
 Management – make the patient lie down flat
with legs raised
- i.m. 1ml in 1000 adrenaline repeated after 15
min. till improvement
- low i.v. infusion 10-20mg chlorpheniramine
- i.v.200mg hydrocortisone sodium succinate
- oxygen administration & medical help
16

17. Cerebrovascular accidents
(stroke)
 Usually occurs in hypertensive patients
 Clinical features – depends on site & extend
of brain damage
- loss of consciousness
- weakness of arm & leg on one side
- drooping of one side of face
 Management – maintenance of airway
- hospitalization
17

18. Asthmatic attacks
 Causes – anxiety, exposure of allergen,
infection
 Clinical features – breathlessness, wheezing,
use of accessory muscles for respiration
 Management – reassurance of patient
- patient should never be allowed to lie down
flat
- inhalation of salbutamol nebulizer
18

19. Cont.
- oxygen administration
- if no response slow i.v. salbutamol
- i.v. 200mg hydrocortisone sodium succinate
- hospitalization
19

20. Bleeding
 Occurs mainly after extraction
 Occurs in hemorrhagic disorders (hemophilia
A, Christmas disease, Vit. K deficiency,
anticoagulant therapy, liver disease,
congenital cyanotic heart disease, c/c renal
failure)
 Management – reassurance of patient
- oral cavity is cleaned & source of bleeding is
identified
20

21. Cont.
- socket is sutured
- local hemostatic measures – pressure packs
- if bleeding persists hospitalization
21

22. Drug reactions
 Anaphylaxis
 Allergy to LA solution
 Hypotension due to interaction of i.v.
barbiturates with antihypertensive drugs
22

23. Reaction due to LA
 Causes – i. v. injection of LA
- allergy to LA
 LA may cause cardiovascular effects & facial
palsy
 I.V. injection is caused by – aspiration was
not carried out during injection & rapid
infusion of LA
23

24. Cont.
- Clinical features – drowsiness
- agitation
- loss of consciouness
- Management – make the patient lie down flat
- maintain airway
- recovery in 30 min.
24

25. Cont.
 Allergy to LA – management similar to
anaphylaxis
 Cardiovascular effects - Manifested as
palpitation
- If MI – manage MI
 Facial palsy – temporary effect
- caused by tackling of LA to facial nerve
25

26. Cont.
- management – wears of gradually
-reassurance of patient
26

27. Hypotension
 Prevented by proper drug history before
procedure
 Management – maintenance of airway
- patient is made to lie down flat
- artificial ventilation if required
- medical help
27

28. Hypertension
 Management – medical assistance
28

29. Traumatic injury
 Burns
 Laceration
 Fractures of jaw
29